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By Tim GhianniREUTERS • Friday October 5, 2012 6:36 AM

NASHVILLE — A steroid medication linked to the death of at least five people from rare fungal meningitis might have been administered to patients in 23 states, including Ohio, the U.S. Centers for Disease Control and Prevention said yesterday, raising fears that the rare outbreak could spread.

The CDC said five people had died so far and 35 had fallen sick from fungal meningitis in six states. The outbreak was first reported in Tennessee, where three people have died and 25 of the cases have been reported.

The other confirmed deaths were in Virginia and Maryland.

“We do know there were over 700 patients in Tennessee who were exposed,” said Dr. William Schaffner, an infectious-disease expert at Vanderbilt University School of Medicine in Nashville.

The CDC said it had not yet determined the rate of infection among those patients who received the potentially tainted steroid. The rate of infection is important for determining the potential for the outbreak to spread.

“At the moment, fortunately, the attack rate looks pretty low — less than 1 percent — but we are still in the early days of defining this thing,” Schaffner said.

The steroid is administered to patients, usually by injection, primarily to control back pain.

All the cases so far have been traced to three lots of methylprednisolene acetate from a pharmaceutical compounding plant in Massachusetts, the CDC said.

The company, New England Compounding Center Inc., or NECC, in Framingham, Mass., prepared the medication, which has been voluntarily recalled.

“We are encouraging all health facilities to immediately cease use of any product produced by NECC,” said Dr. Madeleine Biondolillo, Massachusetts public health director of safety.

A fungus linked to the steroid medication has been identified in specimens from five patients, according to the CDC’s Dr. Benjamin Park.

The Massachusetts Health Department said there were 17,676 vials in each of the three lots under investigation. They were sent out in July through September and have a shelf life of 180 days.

Patients who received the injections were at risk of developing fungal meningitis for at least a month after their last exposure, Schaffner said.

“There is a fairly long incubation period. … That hasn’t run out yet for many patients,” Schaffner said. “ Over the next few weeks, we are going to see a progressive accumulation of cases.”< /p>

Fungal meningitis is rare and life-threatening but is not passed from person to person. Meningitis can reach humans in steroid medications, which weaken the immune system. Symptoms include fever, headache, stiff neck, nausea and vomiting.

About 75 facilities could have received the steroid. Besides Ohio, they’re in California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas and West Virginia.